Case 2 - Managing HIV Therapy in Patients with Comorbidities

Infectious Diseases
Curriculum:
Challenging Cases in HIV Management: The Patient Waiting Room
Credits:
0.75 AMA PRA Category 1 Credit(s)™
Launch Date:
March 31, 2016
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Infectious disease specialists, HIV treaters, and other health care professionals involved in the treatment of patients with HIV.

Relevant Terms:

HIV, HIV treatment regimens

Paul E. Sax, MD

Paul E. Sax, MD
Clinical Director
Division of Infectious Diseases
Brigham and Women's Hospital Professor of Medicine
Harvard Medical School
Boston, MA

Dr. Paul E. Sax is Clinical Director of the Division of Infectious Diseases and the HIV Program at Brigham and Women's Hospital (BWH), and Professor of Medicine at Harvard Medical School. Dr. Sax received his MD from Harvard Medical School in 1987. He served his residency in Internal Medicine at BWH, while continuing his postdoctoral education with a fellowship in the Infectious Disease Unit of Massachusetts General Hospital. Dr. Sax is board certified in Internal Medicine and Infectious Diseases. He is Editor-in-Chief of Open Forum Infectious Diseases, is on the Peer Review board of the HIV/AIDS Section of UpToDate, and the editorial advisory board of Medscape HIV/AIDS. Dr. Sax is also on the core faculty of the International AIDS Society - USA and the New England AIDS Education and Training Center. In addition to his clinical and teaching work, Dr. Sax's ongoing areas of research include clinical trials of antiretroviral therapies, cost-effectiveness of management strategies for HIV, and toxicity of antiretroviral therapy. He is presently the principal investigator at the BWH AIDS Clinical Trials Unit, and is a member of the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) Research Group.
 

Grace A. McComsey, MD

Grace A. McComsey, MD
Professor of Medicine and Pediatrics
Division Chief
Pediatric Infectious Diseases and Rheumatology
Case Western Reserve University
Cleveland Clinic
Cleveland, OH

Grace A. McComsey, MD, has been involved in HIV research for 15 years, 11 as NIH-funded principal investigator. Her work, since its inception, had focused on the investigations of lipodystrophy in HIV. Her work was paramount in showing the link between NRTI-induced mitochondrial toxicity and the loss of peripheral fat (lipoatrophy) in HIV-infected individuals on antiretrovirals. Her work was recognized in 2007 by the HIV Medical Association of the Infectious Diseases Society of America that awarded her the "HIVMA Leader in HIV Research Award", specifically in recognition of her work "in advancing our understanding of lipodystrophy in HIV". She has personally led a number of studies, including several multicentered, investigating different means to prevent or treat fat alterations in HIV, including uridine supplements, rosiglitazone, statins, and modulation of antiretroviral therapy dose and type. She also led several ACTG studies showing that central fat accumulation (lipohypertrophy component of lipodystrophy) continues to be a major threat to the success of current HIV treatment.

In the last 8 years, she has led the Case HIV Metabolic Center, which is recognized for clinical and translational studies highlighting the pathogenesis and management of metabolic and cardiovascular complications in HIV-infected adults and children. Over the last few years, the focus of her research investigations has been on elucidating the role of inflammation and immune activation (and interventions targeting inflammation/immune activation) in common co-morbidities in HIV, including lipohypertrophy and atherosclerosis. In addition, she has been very actively involved in the training of numerous post-doctoral fellows and junior faculty members, several of whom have obtained NIH or CFAR research funding.

Edgar T. Overton, MD

Edgar T. Overton, MD
Associate Professor of Medicine
Medical Director
UAB 1917 HIV Clinic
Birmingham, AL

Dr. Overton currently serves as the medical director of the UAB 1917 HIV Clinic, where his clinical focus involves the improvement of health care delivery to the patients living with HIV and HCV. He is an UAB Center for AIDS Research (CFAR) Associate Scientist. He is the Site Leader for the AIDS Clinical Trial Unit at UAB and currently serves as the Vice Chair of the End Organ Disease/Inflammation Transformative Science Group for the AIDS Clinical Trials Group. He is an investigator on several national protocols addressing various metabolic complications of HIV, including osteoporosis, diabetes, and coinfection with HCV. His research interests focus on the long-term complications of HIV, particularly the interface between persistent inflammation and immune activation as they relate to the increasing prevalence of comorbidities seen among HIV-infected persons. He is an investigator on the NHLBI-funded REPRIEVE Trial which is evaluating the role of Pitavastatin to reduce atherosclerotic cardiovascular disease in HIV.
 
 
 
1. Utilize evidence-based guidelines as well as clinical knowledge of available and emerging therapies to develop initial HIV treatment regimens based on individual patient characteristics.
2. Review the cost-effectiveness of available HIV therapies.
3. Develop simplified HIV treatment regimens that reflect patient preference and increase adherence.
4. Differentiate available and emerging HIV treatment regimens based on resistance profile.
5. Apply knowledge of effective switch strategies and NRTI-sparing regimens that have demonstrated a low risk of virological failure in patients who would benefit from treatment alteration.

Provider Statement:
This continuing medical education activity is provided by
Educational Partner:
 
 
Support Statement:
This activity is supported by an educational grant from ViiV Healthcare.
 
Activity Chair:
Paul E. Sax, MD
Clinical Director
Division of Infectious Diseases
Brigham and Women's Hospital Professor of Medicine
Harvard Medical School
Boston, MA     
 
Disclosures:
Advisory Board: AbbVie, Bristol-Myers Squibb, GlaxoSmithKline/ViiV, Gilead, Janssen, Merck
Investigator: Bristol-Myers Squibb, GlaxoSmithKline/ViiV, Gilead, Merck
 
Faculty:
Grace A. McComsey, MD
Professor of Medicine and Pediatrics
Division Chief
Pediatric Infectious Diseases and Rheumatology
Case Western Reserve University
Cleveland Clinic
Cleveland, OH
 
Disclosures:
Advisory Board: Bristol-Myers Squibb, Gilead, ViiV
Consultant: Bristol-Myers Squibb, Gilead, ViiV
Investigator: AstraZeneca, Bristol-Myers Squibb, Gilead, ViiV
 
Edgar T. Overton, MD
Associate Professor of Medicine
Medical Director
UAB 1917 HIV Clinic
Birmingham, AL
 
Disclosures:
Contracted Research (paid to institution): Bristol-Myers Squibb, Gilead, Janssen
 
External Reviewer:
Rebecca A. Clark, MD
No relevant financial relationships to disclose.
 
National Jewish Health and Vindico Medical Education staff report the following relationship(s):
No relevant financial relationships to disclose.
 
Signed disclosures are on file at National Jewish Health, Office of Professional Education, and Vindico Medical Education, Office of Medical Affairs and Compliance.
 
Disclosures:
In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all planners, teachers, authors, and reviewers involved in the development of CME content are required to disclose to the accredited provider their relevant financial relationships. Relevant financial relationships will be disclosed to the activity audience prior to viewing content.
 
Accreditation:
National Jewish Health is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. 
 
Credit Designation:
National Jewish Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 
This enduring material is approved for 1 year from the date of original release, March 31, 2016 to March 31, 2017.
 
How to Participate in this Activity and Obtain CME Credit:
To participate in this CME activity, you must reference the objectives, answer the pretest questions, watch, read, and listen to the content, complete the CME posttest, and then fill in the evaluation. Provide only one (1) correct answer for each question. A satisfactory score is defined as answering 66% of the posttest questions correctly. Upon receipt of the completed materials, if a satisfactory score on the posttest is achieved, National Jewish Health will issue an AMA PRA Category 1 Credits™ Certificate.
 
Overview: People living with HIV are often affected by multiple chronic diseases that pose complex challenges for providers, especially regarding drug management. In this interactive, case-based activity, a variety of topics pertaining to the treatment of patients with HIV and other comorbidities will be reviewed. Expert commentaries offered by faculty will cover key issues, such as selecting appropriate HIV treatment given specific comorbidities, assessing for potential drug interactions, and developing strategies to maximize safety.
 
Target Audience: The intended audience for the activity is infectious disease specialists, HIV treaters, and other health care professionals involved in the treatment of patients with HIV.
 
Learning Objectives:
Upon successful completion of the educational series, participants should be better able to:
  • Utilize evidence-based guidelines as well as clinical knowledge of available and emerging therapies to develop initial HIV treatment regimens based on individual patient characteristics.
  • Review the cost-effectiveness of available HIV therapies.
  • Develop simplified HIV treatment regimens that reflect patient preference and increase adherence.
  • Differentiate available and emerging HIV treatment regimens based on resistance profile.
  • Apply knowledge of effective switch strategies and NRTI-sparing regimens that have demonstrated a low risk of virological failure in patients who would benefit from treatment alteration.
Unlabeled and Investigational Usage:
The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage. All activity participants will be informed if any speakers/authors intend to discuss either non-FDA approved or investigational use of products/devices.
 
Copyright Statement:
Created and published by Vindico Medical Education, 6900 Grove Road, Building 100, Thorofare, NJ 08086-9447. Telephone: 856-994-9400; Fax: 856-384-6680. Printed in the USA. Copyright © 2016 Vindico Medical Education. All rights reserved.
 
No part of this publication may be reproduced without written permission from the publisher. The material presented at or in any of National Jewish Health and Vindico Medical Education continuing education activities does not necessarily reflect the views and opinions of National Jewish Health and Vindico Medical Education. Neither National Jewish Health, nor Vindico Medical Education, nor the faculty endorse or recommend any techniques, commercial products, or manufacturers. The faculty/authors may discuss the use of materials and/or products that have not yet been approved by the US Food and Drug Administration. All readers and continuing education participants should verify all information before treating patients or utilizing any product.
 
CME Questions?
Contact us at:
National Jewish Health: proed@njhealth.org or 303-398-1000.
Vindico Medical Education: cme@vindicocme.com or 856-994-9400, ext. 504.
 
COURSE VIEWING REQUIREMENTS
Supported Browsers:
Internet Explorer 9.0+ for Windows 2003, Vista, XP, Windows 7, Windows 8.1 
Google Chrome 28.0+ for Windows, Mac OS, or Linux
Mozilla Firefox 23.0+ for Windows, Mac OS, or Linux
Safari 6.0+ for Mac OSX 10.7 and above
Supported Phones & Tablets:
Android 4.0.3 and above
iPhone/iPad with iOS 6.1 or above